Ibandronate Sodium (Boniva®)

Covered: IV ibandronate (Boniva) is covered only for the FDA‑approved indication—treatment of osteoporosis in postmenopausal women at high risk for fracture (history of fragility fracture, T‑score ≤ −2.5, or T‑score −1.0 to −2.5 with high fracture risk); non‑FDA uses are excluded. Key requirements: approval is limited to 3 mg IV every 3 months for up to 12 months (reauthorization requires documented clinical benefit), and patients must have documentation of high‑risk criteria, calcium ≥ reference range or on calcium supplementation, creatinine clearance ≥30 mL/min, and either a 12‑month oral bisphosphonate trial with inadequate efficacy or documentation of intolerance/inability to take oral bisphosphonates or a prior IV bisphosphonate, with all supporting records submitted.

"Treatment of osteoporosis in postmenopausal women (FDA-approved indication)."

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